Native vs. synthetic grafts in lower extremity vascular trauma: Lessons from two rural case presentations

Trauma to the extremities is a common injury that demands a comprehensive evaluation of vascular structures. Prompt identification and timely intervention improve clinical outcomes; severe injuries frequently lead to complications and potential limb loss. Revascularization delays greater than 8 h post-injury markedly increase amputation risk. This report describes successful management strategies for lower extremity vascular injuries by comparing native and synthetic graft applications.

Two patients with lower extremity vascular injuries are detailed. Case 1: a 54-year-old female with blunt trauma to the right leg that resulted in femoropopliteal occlusion successfully underwent a saphenous vein graft (SVG) bypass. Case 2: a 28-year-old female presented 27 h post-road traffic collision with a left thigh injury and total transection of the superficial femoral artery. Revascularization was achieved via femoropopliteal extra-anatomic bypass using an expanded polytetrafluoroethylene (ePTFE) vascular graft. Both patients were discharged 2 weeks post-surgery with favorable outcomes.

Case 1 emphasizes the importance of prompt diagnosis and intervention. Case 2 demonstrates limb salvage potential despite delayed presentation. The choice between autologous SVGs (superior biocompatibility, long-term patency) and synthetic ePTFE grafts (readily available, higher re-occlusion risk) dictates postoperative management, particularly in terms of anticoagulation therapy.

This report illustrates successful open surgical bypasses for femoropopliteal occlusion and ruptured superficial femoral artery. It underscores the importance of timely intervention and differing postoperative management methods for autologous SVGs and synthetic ePTFE grafts. An algorithmic approach to diagnosis and treatment, alongside surgeon comprehension of therapeutic options, is paramount for optimal outcomes.